How to treat insomnia in patients who smoke?

Question

Hi doctor,

I have been suffering from insomnia for so long that I can not even remember the last time I slept normally. If I want to sleep for 8 hours and go to bed on time it does not happen. I usually spend around 24 hours awake to exhaust myself enough so that I can sleep, and I feel that this is causing too many other problems with it. I think so because I have GAD and since I have been diagnosed with it, I get depression episodes and lose the ability to communicate with my friends or family. I depersonalize myself at times but it does not last long and even though it rarely happens, it scares me when it does. I have been prescribed a ton of different medicines but all they do is just numb my feelings. They turn me from sad to completely numb. Yes, I smoke but I am not a chain smoker or you can say I barely smoke around 5 cigarettes a day or less. Currently, I am trying to quit by having one cigarette every 24 hours. But I do not know that smoking has anything to do with my symptoms since I started smoking four years back.

Thank you.

Answer 1

Hi,

We welcome you to icliniq family.

Thank you for taking help from a psychiatrist. I can understand your situation. You may have mixed anxiety and depressive disorder. There is non-pharmacological management for it. I would suggest you follow the below guidelines to deal with it.

Try to do exercises daily for 30 to 45 minutes. or go for a walk at least.
Try to do meditation for 20 minutes daily, sit in one place in a comfortable position, and try to concentrate on your normal breathing. Do not stop or force yourself to stop your thoughts, just let it be.
Go for healthy home-cooked foods, and avoid junk foods.
Keep drinking water and hydrate yourself.
You should spend quality time with friends and family daily or do video calls if you are living away from your family.
You should spend time on creative hobbies like reading good books, writing journals, painting, drawing, and learning new skills or language or musical instruments.
Avoid tobacco or alcohol or any substance abuse.

For your sleep hygiene:

You should take 7 to 8 hours of sleep daily.
You need to fix your time for sleep, which means you must fix the time to sleep and awake.
You must not do any other activities in bed.
You must not just lie down on the bed without any reason, the bed is just meant for sleep.
Wear loose and comfortable clothes for sleep.
Take light food at night or dinner at least 3 hours before sleep.
You can take a maximum of 20 minutes of nap a day.
Do not use your mobile or TV or laptop for at least half an hour before sleep.
Try to maintain an adequate temperature in your room, which means not so cold not so hot.
Go for a proper bed and pillow.
Ensure that no noise or disturbance occurs at night.
Go for warm milk with turmeric before sleep.

I would like to advise you to live your life, not just spend it. Be bold and confident. If you still have symptoms that persist after following the advice for 10 days then I can recommend medication that will not numb your feelings. I also recommend you go for the following blood test report.

CBC (complete blood count).
Thyroid profile
Vitamin B12
Vitamin D3

Thank you.